This resource examines reimbursement structures that serve beneficiaries who are dually eligible for Medicare and Medicaid. It also includes an analysis comparing care patterns for dual-eligible beneficiaries with those of Medicare-only patients. The findings and recommendations include:
- On average, dual-eligible beneficiaries have risk scores that are 50 percent higher than the average risk score for all other Medicare beneficiaries.
- One-tenth of the dual-eligible population accounted for 38.5 percent of total combined Medicare and Medicaid spending on all dual-eligible beneficiaries in 2011.
- Average annual Medicare spending for dual-eligible beneficiaries is more than twice as high as average annual Medicare spending for all other Medicare beneficiaries.
- Dual-eligible beneficiaries have higher rates of hospitalizations and re-hospitalizations for medical conditions such as hypertension, congestive heart failure, and chronic obstructive pulmonary disease. Comprehensive care can often prevent the need for a hospital inpatient admission for treatment of these conditions.
- Bipartisan Policy Center recommendations include changes to existing reimbursement structures, consolidating regulatory authority for dual-eligible programs within the Medicare-Medicaid Coordination Office at the Centers for Medicare and Medicaid Services, and building on lessons learned from existing programs to develop a consolidated framework for program design.
- How do care patterns of beneficiaries eligible for both Medicare and Medicaid compare with those of Medicare-only beneficiaries?
- What policy actions can be taken to better integrate clinical and non-clinical services for high-need patients?